Citation Nr: 1320109 Decision Date: 06/21/13 Archive Date: 07/02/13 DOCKET NO. 12-20 184 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUES 1. Entitlement to service connection for chronic pain syndrome (other than lumbago and chronic back pain). 2. Entitlement to service connection for back disability with lumbago and chronic back pain. 3. Entitlement to service connection for heart disability. 4. Entitlement to service connection for kidney stones. 5. Entitlement to service connection for epididymitis (also claimed as burning feeling in testicles). 6. Entitlement to service connection for bilateral foot fungus (also claimed as foot problems). 7. Entitlement to service connection for depression and anxiety disorder (also claimed as short and long term memory loss). REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD L. Crohe, Counsel INTRODUCTION The Veteran had active military service from July 1979 to April 1981. This matter comes before the Board of Veterans' Appeals (Board) from a May 2012 rating decision of the New Orleans, Louisiana Regional Office (RO) of the Department of Veterans Affairs (VA) that denied the benefits sought. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). The issues of entitlement to service connection for back disability with lumbago and chronic pain, epididymitis (also claimed as burning feeling in testicles), and depression and anxiety disorder (also claimed as short and long term memory loss are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. The Veteran's heart murmur is congenital and there is no superimposed disease or injury or in-service aggravation of his congenital disorder of record; heart disease was not manifest in service, within a year of discharge and is not shown to be causally related to active military service. 2. The Veteran does not have bilateral foot fungus that is the result of a disease or injury in active duty service. 3. The Veteran does not have kidney stones that are the result of a disease or injury in active duty service. 4. The Veteran does not have chronic pain syndrome (other than lumbago and chronic back pain) that is the result of a disease or injury in active duty service. CONCLUSIONS OF LAW 1. The criteria for service connection for a heart condition have not been met. 38 U.S.C.A. §§ 1131, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.303, 3.307, 3.307, 4.9 (2012). 2. The criteria for establishing service connection for bilateral foot fungus have not been met. 38 U.S.C.A. §§ 1131, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). 3. The criteria for establishing service connection for kidney stones have not been met. 38 U.S.C.A. §§ 1101, 1131, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). 4. The criteria for establishing service connection for chronic pain syndrome (other than lumbago and chronic back pain) have not been met. 38 U.S.C.A. §§ 1131, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify & Assist The Veterans Claims Assistance Act (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002 & Supp. 2012)) redefined VA's duty to assist the appellant in the development of a claim. VA regulations for the implementation of the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2012). The notice requirements of the VCAA require VA to notify the Veteran of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, the VA will attempt to obtain. 38 C.F.R. § 3.159(b) (2012). The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between the Veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VCAA notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (in this case, the RO). Id; see also Pelegrini v. Principi, 18 Vet. App. 112 (2004). However, insufficiency in the timing or content of VCAA notice is harmless if the errors are not prejudicial to the claimant. Conway v. Principi, 353 F.3d 1369, 1374 (Fed. Cir. 2004) (VCAA notice errors are reviewed under a prejudicial error rule). In November and December 2010 and July 2011 letters, issued prior to the rating decision on appeal, the RO provided notice to the Veteran regarding what information and evidence is needed to substantiate a claims for service connection, as well as what information and evidence must be submitted by the Veteran and what information and evidence will be obtained by VA. The letters also advised the Veteran of how the VA determines a disability rating and assigns an effective date, and the type of evidence which impacts such. The case was last readjudicated in July 2012. The VCAA also requires VA to make reasonable efforts to help a claimant obtain evidence necessary to substantiate his claims. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c), (d). This "duty to assist" contemplates that VA will help a claimant obtain records relevant to his claim, whether or not the records are in Federal custody, and that VA will provide a medical examination or obtain an opinion when necessary to make a decision on the claim. 38 C.F.R. § 3.159(c)(4). The claims folder contains the Veteran's service personnel and treatment records, as well as all identified and available post-service treatment records from the Alexandria VA Medical Center (VAMC) dated from April 1999 to July 2012. The record reflects that the Veteran has been awarded Social Security Administration (SSA) disability benefits and that records associated with the SSA decision have not been associated with the claims file. See November Report of General Contact and August 2011 VA examination report. The Board has considered the holding of Tetro v. Gober, 14 Vet .App. 110 (2000), and other cases, wherein the Court held that VA has a duty to request information and pertinent records from other Federal agencies, when on notice that such information exists. As the record shows that the Veteran was awarded SSA disability benefits for a back disability, there is no reasonable possibility that the SSA records in question would be relevant to the claims decided on the merits below, including service connection for a heart condition, kidney stones, bilateral foot fungus, and chronic pain syndrome (other than lumbago and chronic back pain). Therefore, the Board finds that a remand to obtain these records is not necessary. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the claimant are to be avoided). A review of Virtual VA does not reveal any additional documents pertinent to the present appeal. Under the VCAA, VA is obliged to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service; and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C.A. §5103A(d); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The types of evidence that "indicate" that a current disability "may be associated" with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. McLendon at 83. The threshold for finding a link between current disability and service is low. Locklear v. Nicholson, 20 Vet. App. 410 (2006); McLendon at 83. The Veteran was afforded a VA examination for his heart condition that was based on an interview with the Veteran a review of the claims file, examination and was adequate to adjudicate the claim. See Barr v. Nicholson, 21 Vet. App. 303 (2007). The Veteran was not afforded VA examinations for kidney stones, bilateral foot fungus, or chronic pain syndrome and such examinations are not required. As discussed below, the evidence does not establish a relevant event, injury or disease in service potentially associated with the current disorders. The Veteran has not identified any symptoms that he had in service or since service, the evidence does not reflect any such problems in service, and there is no other competent medical or lay evidence that the Veteran's current kidney stones, heart condition, or bilateral foot fungus may be related to service. VA examinations are therefore not necessary. See McLendon, 20 Vet. App. at 83. For the reasons set forth above, the Board finds that VA has complied with the VCAA's notification and assistance requirements. The appeal is thus ready to be considered on the merits. II. Legal Criteria Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty in active service or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. § 3.303 (2012). In interpreting section 1131 of the statute and section 3.303(a) of the regulations, the United States Court of Appeals for the Federal Circuit (Federal Circuit) held that a three-element test must be satisfied in order to establish entitlement to service connection. Specifically, the evidence must show (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service (the "nexus" requirement). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (citing Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004))). Under 38 C.F.R. § 3.303(b), claims for certain chronic diseases-namely those listed in 38 C.F.R. § 3.309(a) -benefit from a somewhat more relaxed evidentiary standard. See Walker, 708 F.3d 1331 (holding that "[t]he clear purpose of the regulation is to relax the requirements of § 3.303(a) for establishing service connection for certain chronic diseases."). When a chronic disease is established during active service, then subsequent manifestations of the same chronic disease at any later date, however remote, will be entitled to service connection, unless clearly attributable to causes unrelated to service ("intercurrent causes"). 38 C.F.R. §3.303(b). In order to establish the existence of a chronic disease in service, the evidence must show a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Id. Thus, the mere manifestation during service of potentially relevant symptoms (such as joint pain or abnormal heart action in claims for arthritis or heart disease, for example) does not establish a chronic disease at that time unless the identity of the disease is established and its chronicity may not be legitimately questioned. Id. If chronicity in service is not established, then a showing of continuity of symptoms after discharge is required to support the claim. Id. The Federal Circuit noted that the requirement of showing a continuity of symptomatology after service is a "second route by which a veteran can establish service connection for a chronic disease" under subsection 3.303(b). 708 F.3d 1331. Showing a continuity of symptoms after service itself "establishes the link, or nexus" to service and also "confirm[s] the existence of the chronic disease while in service or [during the] presumptive period." Id. (holding that section 3.303(b) provides an "alternative path to satisfaction of the standard three-element test for entitlement to disability compensation"). Significantly, the Federal Circuit indicated that showing a continuity of symptomatology after service is a lesser evidentiary burden than the nexus requirement of the three-part test discussed above: " The primary difference between a chronic disease that qualifies for § 3.303(b) analysis, and one that must be tested under § 3.303(a), is that the latter must satisfy the 'nexus' requirement of the three-element test, whereas the former benefits from presumptive service connection . . . or service connection via continuity of symptomatology" (emphasis added). Id. Not all diseases that may be considered "chronic" from a medical standpoint qualify for the relaxed evidentiary standard under section 3.303(b). Rather, the Federal Circuit held that this subsection only applies to the specific chronic diseases listed in 38 C.F.R. § 3.309(a). Id. Thus, if the claimant does not have one of the chronic diseases enumerated in section 3.309(a), then the more relaxed continuity-of-symptomatology standard does not apply, and "medical nexus of a relationship [sic] between the condition in service and the present condition is required." Id. The Board must assess the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). This evaluation generally involves a three-step inquiry. First, the Board must determine whether the evidence is competent. See, e.g. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). Second, the Board must determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007) (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). Third, the Board must assess the probative value and weight of the evidence in light of the entire record. Gonzales, 218 F.3d at 1380-81. As observed by the Federal Circuit, lay evidence must "demonstrate some competence." See King v. Shinseki (Fed. Cir. 2012) (citing 38 U.S.C.A. § 5107(b) and 38 C.F.R. § 3.307(b)) (internal quotation marks omitted). The Board may therefore discount the probative value of lay evidence if it finds such evidence not to be competent. See id.; see also Layno v. Brown, 6 Vet. App. 465, 469 (1994) (holding that in order for testimony to be probative of any fact, the witness must be competent to testify as to the facts under consideration). However, the Board may not "categorically" require medical evidence or disregard lay evidence without first assessing its competence. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (holding that it was error in a cause-of-death claim to find "categorically" that a medical opinion was required to prove a nexus between the Veteran's service-connected mental disorder and his drowning death, and likewise to reject categorically the claimant's testimony on this issue as not competent simply because she was a lay person); see also Kahana v. Shinseki, 24 Vet. App. 428, 434 (2011) (holding that the Board erred in categorically rejecting lay evidence without analyzing and weighing it). Importantly, lay statements submitted by or on behalf of a claimant can be competent with respect to both the diagnosis and the etiology or cause of a disability. See Davidson, 581 F.3d at 1316. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. See 38 C.F.R. § 3.159(a)(2); Layno, 6 Vet. App. at 469 (holding that lay testimony is not competent to prove that which would require specialized knowledge, training, or medical expertise). Lay evidence is competent if it is provided by a person who has first-hand knowledge of facts or circumstances, or conveys matters that can be observed and described by a lay person. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (holding that appellant was competent to testify as to factual matters of which he had first-hand knowledge, such as experiencing pain in his right hip and thigh in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy). For example, the Court has held that a lay person is competent to diagnose a disease with "unique and readily identifiable features" such as varicose veins. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Similarly, the Court has found a lay person competent to identify tinnitus and flat feet, which are disorders that can be identified based on lay observation alone. See Charles v. Principi, 16 Vet. App. 370 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398 (1995) (flatfeet). However, lay testimony is not competent with respect to determinations that are "medical in nature" or require medical knowledge due to their complexity. See Barr, 21 Vet. App. at 309. For example, the Court held that a claimant was not competent to determine whether he had rheumatic fever, which was a more medically complex condition. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). The Federal Circuit has held that lay evidence may be competent and sufficient to establish a diagnosis of a condition in the following circumstances: (1) when the condition is simple, such as a broken leg, as opposed to when the condition is more complex, such as a form of cancer; (2) when the layperson is reporting a contemporaneous medical diagnosis, or; (3) when lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372, 1377 & n4 (Fed. Cir. 2007). Competent medical evidence, as distinguished from lay evidence, is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. 38 C.F.R. § 3.159(a)(1). Competent medical evidence may include statements conveying sound medical principles found in medical treatises. Id. It would also include statements contained in authoritative writings such as medical and scientific articles and research reports or analyses. Id. The competency of evidence differs from the weight assigned to the evidence, which varies according to its credibility and probative value. See Layno, 6 Vet. App. at 469; accord Rucker v. Brown, 10 Vet. App. 67, 74 1997); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (stating that "although interest may affect the credibility of testimony, it does not affect competency to testify."). The Board discounts the weight of evidence it finds not to be credible. See Washington, 19 Vet. App. at 368 (noting that the witness's credibility affects the weight to be given to his testimony). In determining whether statements submitted by a veteran are credible, the Board may consider their internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. at 711, aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table); see also Madden v. Brown, 125 F.3d 1447 (Fed Cir. 1997) (holding that the Board has the "authority to discount the weight and probative value of evidence in light of its inherent characteristics in its relationship to other items of evidence"). Further, the Federal Circuit has held that while the absence of contemporaneous medical records does not, in and of itself, render lay testimony not credible, the Board may weigh the absence of contemporaneous records when assessing the credibility of lay evidence. See Buchanan, 451 F.3d at 1336 ("Nor do we hold that the Board cannot weigh the absence of contemporaneous medical evidence against the lay evidence of record."). Moreover, although the Board cannot reject a claimant's statements merely because he is an interested party, the claimant's interest may affect the credibility of his testimony when considered in light of the other factors. See Cartright, 2 Vet. App. at 25; accord Buchanan, 451 F.3d at 1337 (holding that "the Board, as fact finder, is obligated to, and fully justified in, determining whether lay evidence is credible in and of itself, i.e., because of possible bias . . . ."). III. Analysis A. Heart disability The Board notes that every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or when clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C.A. §§ 1111, 1137. Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304(b). A preexisting injury or disease will be considered to have been aggravated by active service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(a). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(b); Falzone v. Brown, 8 Vet. App. 398, 402 (1995). On his October 2010 Formal Claim, the Veteran reported that he had a heart condition with an unknown date of onset. On his July 2012, Form 9, in relation to all of his claims on appeal, he generally stated that the "issues are service connected since I was treated for them while in service and continue to have problems with them." A review of the Veteran's service treatment records (STRs) show that on June 1979 Report of Medical History, he answered "No" when asked if he currently had or ever had, shortness of breath, pain or pressure in chest, palpitation or pounding heart, heart trouble, or high or low blood pressure. On accompanying June 1979 entrance examination, a clinical evaluation revealed that the heart was abnormal. A systolic murmur was detected. A cardiology consultation was requested, and a chest X-ray was deemed normal. An echocardiogram showed borderline right axis deviation that was probably normal in a 19 year old. The examining physician noted that the cardiac murmur was first noted on the Veteran's enlistment physical. There was no history of any heart problems in infancy or childhood. He had no exertional chest pain, unusual dyspnea on exertion, syncope, or palpitations. On physical examination, the chest wall was fairly thin. The lungs were clear to auscultation and percussions. The point of maximum impulse (PMI) of the heart was normal. There was a soft Grade I/IV midsystolic crescendo - crescendo murmur heard along the left sternal border. The murmur essentially disappeared with valsalva maneuver and increased with exercise. The impression was functional flow murmur and he was deemed fit for enlistment. A July 1979 prescription note revealed an innocent heart murmur and that the Veteran was fit for enlistment. Hence, the presumption of soundness does not attach and 38 U.S.C.A. § 1153 applies. If a presumption of aggravation under section 1153 arises, due to an increase in a disability in service, the burden shifts to the government to show a lack of aggravation by clear and unmistakable evidence that the increase in disability is due to the natural progress of the disease. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306 (2012). The Veteran's STRs reflect that there were no further complaints related to the murmur, or any other heart problems or heart disease for the remainder of the Veteran's active service. A March 1981 chest X-ray was negative. On March 1981 Report of Medical History, the Veteran answered "No" when asked if he currently had or ever had, shortness of breath, pain or pressure in chest, palpitation or pounding heart, heart trouble, or high or low blood pressure. On March 1981 separation Report of Medical Examination a clinical evaluation of the lungs, chest, and heart were normal. His sitting blood pressure was 90/60 and his sitting pulse rate was 78. Post service treatment records from the Alexandria VA Medical Center dated from April 1999 to July 2012, included a December 1999 treatment record that noted a history of congential heart murmur. Multiple treatment records dated from August 2001 through June 2010 revealed on physical examination that there was no murmur and PMI was not displaced. A June 2010 electrocardiogram (EKG) was normal. The Veteran's lungs were clear by auscultation, bilaterally. Treatment records dated in June 2011 noted the Veteran's reports of having a "heart condition" that was diagnosed during military service. The Veteran was nonspecific about the diagnosis, but stated that he was told that he had a murmur and a heart condition that would need further evaluation. He indicated that he has not had any heart tests since that time. He reported symptoms of chest pain and palpitations. Physical examination revealed blood pressure at 116/72 and a pulse of 72. His lungs were clear. On auscultation there was a murmur (2/6) and no gallop. The assessment included a heart murmur/chest pain; however, a precious EKG was normal. A September 2011 treatment record listed heart murmurs and chest pain as active problems. On August 2011 VA examination, the examiner reported that the Veteran had a history of a heart condition since birth. The Veteran was noted to have a heart murmur when he came into the military. He was diagnosed with an innocent murmur by a cardiologist and declared fit for duty. He reported that he has not had any treatment for this condition. The examiner noted that there was no history of myocardial infarction, rheumatic fever, hypertension, hypertensive heart disease, heart rhythm disturbance, valvular heart disease including prosthetic valve, congestive heart failure, other heart disease, angina, dizziness, syncope or fatigue. The Veteran has no history of non-productive cough, productive cough, wheezing, non-anginal chest pain, hemoptysis, fever, anorexia, night sweats. He has dyspnea on moderate exertion. No abnormalities were found on cardiac and pulmonary examinations. A stress test showed that the Veteran became winded after walking three blocks. He ultimately walked a quarter of a mile and stopped due to back pain and numbness and tingling in his legs. His heart size was normal. The Veteran was diagnosed with an innocent heart murmur; there was no auscultation on the current examination. The examiner opined that the Veteran's heart murmur was no caused by or a result of the diagnosed heart murmur upon entry to service. The examiner reasoned that the Veteran had a heart murmur diagnosed as innocent at the time of entry in to service and during the current examination no murmur was evident. The examiner added that the Veteran's symptoms of shortness of breath seemed to be primarily related to deconditioning as a result of his back injury and doing no work since being disabled in 1996. In the absence of superimposed disease or injury, service connection may not be allowed for a heart murmur as this is not a disease or injury within the meaning of applicable legislation relating to service connection. 38 C.F.R. §§3.303(c), 4.9. VA regulations specifically prohibit service connection for congenital defects such as a heart murmur unless such defect was subjected to a superimposed disease or injury which created additional disability. See VAOPGCPREC 82-90 (July 18, 1990) (cited at 55 Fed. Reg. 45,711) (Oct. 30, 1990). Superimposed disease or injury is clearly not demonstrated in the Veteran's service treatment records. Finally, heart disease, as distinct from a benign heart murmur has not been shown, either in service or within one year of discharge. While the Veteran claims that he has a heart condition, his assertions are outside his area of competence. The Board observes that laypersons, such as the Veteran are generally not capable of opining on matters requiring medical knowledge. Bostain v. West, 11 Vet. App. 124, 127 (1998). Here, the question of diagnosis of a heart disability is not lay-observable and requires medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). For the reasons set forth above, the Board finds that the preponderance of the evidence is against the claim, and the appeal must therefore be denied. 38 U.S.C.A. § 5107 (West 2002); 38 C.F.R. § 3.102 (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). B. Bilateral Foot Fungus and Kidney Stones On his July 2012 Form 9, in regards to his claimed disability the Veteran generally stated that he was treated the issues in service and has continued to have problems. Here, the Veteran's STRs, including his June 1979 entrance and March 1981 separation Reports of Medical Examination and History, are negative for any complaints, treatment, or diagnoses related to the kidneys and skin disabilities of the bilateral feet. A January 1981 treatment record showed treatment for a wart on his left leg. A clinical evaluation of the feet at separation was normal. At that time, the Veteran also responded "NO", when asked if he had or ever had skin disease, foot trouble, jaundice or hepatitis, kidney stones or blood in urine, or sugar or albumin in the urine. Post service records included treatment records from the Alexandria VAMC. The first documentation of any skin related foot problems was in an August 2001 treatment record, when blisters on the medical and lateral aspect of the left foot were identified and skin on the left foot was found to be dry and flaky. In November 2001, the Veteran was seen in the emergency department for complaints of a rash to the left foot. On examination, there was darkened discoloration to the medial and lateral aspect of the left foot. He claimed that he was seen by a primary care physician and given antifungal medication that was ineffective. He was diagnosed with a fungal infection of the left foot. In August 2011, he was diagnosed with foot fungus. The first documentation of any kidney related problems was in an August 2006 treatment record that noted that the Veteran began to have muscle cramps and went to the emergency room and told he had "something wrong with his kidneys." A September 2008 record noted his reports of having a kidney stone on the left side a month ago. A December 2009 treatment record noted a history of kidney stones. The Board acknowledges that the absence of contemporaneous medical evidence does not in itself preclude a grant of service connection. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). However, in this case, the Veteran has not provided any lay evidence of pertinent symptomatology. For the most part, he has just provided conclusory statements indicating that his claimed disabilities were related to service or that he was treated for his claimed disabilities in service. There is no lay or medical evidence of earlier post-service symptoms or flare-ups of skin related foot problems or kidney problems until the August 2001 and 2006 VA treatment records, respectively. The absence of any evidence of a skin related foot disability or kidney disability for decades after service weighs the evidence against a finding that the Veteran's disabilities were present in service or in the year or years immediately after service. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). There is no other medical or lay evidence of a relationship between the Veteran's current bilateral foot fungus or kidney problems and service, and neither the Veteran nor his representative have alluded to the existence of any such evidence. Neither the Veteran nor his representative have offered any explanation as to why they believe the current bilateral foot fungus and kidney problems are related to service and the record contains no indications that the bilateral foot fungus and kidney problems are related to service. For the foregoing reasons, the preponderance of the evidence is against the Veteran's claims. The benefit-of-the-doubt doctrine is therefore not applicable and the claims for service connection for bilateral foot fungus and kidney stones must be denied. See 38 U.S.C.A. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. at 55-57. C. Chronic Pain Syndrome (other than Lumbago and Chronic Back Pain) On his July 2012 Form 9, in regards to his claimed disability the Veteran generally stated that he was treated for the issue in service and has continued to have problems. The Veteran's STRs, including his June 1979 entrance and March 1981 separation Reports of Medical Examination and History are negative for any complaints, treatment, or diagnoses related to constant pain or a chronic pain disability. STRs reflect that he was treated on multiple occasions between November and December 1980 for complaints of recurring testicular swelling and pain, but such symptoms were related to acute epididymitis, orchitis, and possible gonococcal prostatitis. A Clinical evaluation at separation was normal. At that time, the Veteran also responded "NO", when asked if he had or ever had swollen or painful joints; arthritis, rheumatism, or bursitis; painful shoulder or elbow; or recurrent back pain. Post service treatment records from the Alexandria VA Medical Center dated from April 1999 to July 2012 show multiple reports of pain as it relates to the Veteran's diagnosed back disability, to include chronic back pain, and lumbago for which the Veteran has been prescribed medication for pain management. The Board acknowledges that the Veteran had current complaints of pain; however such complaints were primarily reported as symptoms of the Veteran's back disability that will be separately addressed in the remand below. As a January 2012 deferred rating decision and March 2012 Report of General Information reflect the Veteran's desire to keep the claim of chronic pain syndrome as an issue that was separate and distinct from his back disability and this issue has been developed separately on appeal, the Board has recharacterized the issue as entitlement to service connection for chronic pain syndrome (other than lumbago and chronic back pain) and will precede to address the issue on the merits. On review of the record, at no point during the appeal period has the Veteran been diagnosed with chronic pain syndrome (other than lumbago or chronic back pain), in the absence of proof of present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); See also Degmetich, supra (also interpreting 38 U.S.C. § 1131 as requiring the existence of a present disability for VA compensation purposes). To be present as a current disability, there must be evidence of the condition at some time during the appeals period. Gilpin v. West, 155 F. 3d 1353, 1356 (Fed. Cir. 1998); see also McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (the Gilpin requirement that there be a current disability is satisfied when the disability is shown at the time of the claim or during the pendency of the claim, even though the disability subsequently resolves). The Board notes that VA treatment records show complaints of pain associated with his back disability, however, the Veteran has not identified any symptoms or diagnoses as it relates to his claim of chronic pain syndrome. Also, it has neither been alleged nor shown that he has any type of symptoms of widespread pain or pain symptoms beyond his back disability. With respect to whether the Veteran's own statements can establish a current disability here, his claim of having chronic pain syndrome is inconsistent with the other evidence of record that is negative for a current chronic pain syndrome disability. Also, there have been no reports of, and the evidence does not reflect, any symptomatology of chronic pain syndrome (other than lumbago and chronic back pain). The Board has considered the Veteran's reports of having an additional chronic pain disability; however, Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. Accordingly, the preponderance of the evidence is against the Veteran's claim for chronic pain syndrome and it must be denied. Gilbert, 1 Vet. App. 49, 55 (1990). The benefit-of-the-doubt rule is thus not for application. Service connection for infertility is denied. 38 C.F.R. § 3.303; Brammer, supra; McClain, supra. ORDER Entitlement to service connection for heart disability is denied. Entitlement to service connection for bilateral foot fungus is denied. Entitlement to service connection for kidney stones is denied. Entitlement to service connection for chronic pain syndrome (other than lumbago and chronic back pain) is denied. REMAND In determining when to provide the Veteran with an examination, the threshold for finding a link between current disability and service is low. Locklear, supra.; McLendon, supra. In his June 2011 informal claim, the Veteran stated that his depression with anxiety was caused by his military service. He reported symptoms, including long term and short term memory loss and being unmotivated. In an April 2013 Written brief Presentation, the Veteran's representative reported that the Veteran had a history of behavioral problems in service. The representative indicated that many Veterans seeking service connection for an acquired psychiatric disorder many years after service also had behavioral problems in service. A review of the Veteran's service personnel file reflects that the Veteran failed to report for duty in September 1980 and January 1981, in which he was issued two Article 15s. In March 1981, the Commanding officer recommended that the Veteran be eliminated due to his poor attitude that reflected on his performance, conduct and military bearing. In March 1981, separation was proposed under Chapter 13 due to a finding that the Veteran was unsuitable for service due to apathy. The record stated that the Veteran exhibited complete apathy towards duty performance despite repeated warnings to get his personal affairs in order. It was noted that his frequent absences from duty and lateness necessitated elimination. Post service, a February 2006 VA treatment record reflected that the Veteran tested positive for a screen for depression. Here the evidence is sufficient to satisfy McLendon's low threshold for nexus evidence and, therefore, is a VA medical nexus opinion is required. VA regulations provide that where "diagnosis is not supported by the findings on the examination report or if the report does not contain sufficient detail, it is incumbent upon the rating board to return the report as inadequate for evaluation purposes." 38 C.F.R. § 4.2 (2012). Where the Board makes a decision based on an examination report which does not contain sufficient detail, remand is required "for compliance with the duty to assist by conducting a thorough and contemporaneous medical examination.'" Goss v. Brown, 9 Vet. App 109, 114 (1996); Stanton v. Brown, 5 Vet. App. 563, 569 (1993). The Veteran's STRs reflect that he was treated on multiple occasions between November and December 1980 for complaints of recurring testicular swelling and pain. He was diagnosed with acute epididymitis, orchitis, and possible gonococcal prostatitis. During his August 2011, VA examination, he reported that he had trauma to his testicles when his body was jarred after a fellow soldier dropped a heavy metal bar near him. As the August 2011 VA examiner did not provide an opinion as to whether or not the Veteran's recurrent epididymitis had its onset in service, or was otherwise related to service, the examination is inadequate for purposes of adjudication. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). On November 2010 Report of General Contact, the Veteran also stated that he was in receipt of Social Security Administration (SSA) disability benefits. On August 2011 VA examination report, the examiner noted that the Veteran went on SSA disability benefits for a back condition. To date, SSA records have not been associated with the claims file or Virtual VA eFolder and the record is not clear as to what extent VA requested such records. The Court has long held that the duty to assist includes requesting information and records from the Social Security Administration that were relied upon in any disability determination. See Hayes v. Brown, 9 Vet. App. 67, 74 (1996) (VA is required to obtain evidence from the Social Security Administration, including decisions by the administrative law judge, and give the evidence appropriate consideration and weight); see also 38 U.S.C.A. § 5103A(c)(3); 38 C.F.R. § 3.159(c)(2). Therefore, the Veteran's records determining his entitlement to Social Security benefits must be requested. The record reflects that the Veteran receives ongoing treatment from the Alexandria VA Medical Center, therefore, any relevant treatment records dated since July 2012 should be obtained and associate with the Veteran's claims file or Virtual VA eFolder. See 38 U.S.C.A. § 5103A(b), (c); 38 C.F.R. § 3.159(b) and (e)(2); see also Bell v. Derwinski, 2 Vet. App. 611 (1992) (VA medical records are in constructive possession of the agency, and must be obtained if the material could be determinative of the claim). Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). Expedited handling is requested.) 1. Obtain any relevant VA treatment records from the Alexandria VA Medical Center dated from July 2012 to the present or any other VA medical facility that may have treated the Veteran for any back condition with lumbago and chronic pain, as well as any testicle, and psychiatric disorders and associate those documents either with the claims file or the Virtual VA eFolder. If any such records are unavailable, the Veteran should be notified of the identity of any records that are unavailable, the efforts VA has undertaken to obtain the records, and any further action that may be taken concerning his claims, and he should be notified that he may submit the records himself. All such notification must be documented in the claims file. 2. Contact the SSA and obtain a copy of that agency's decision concerning the Veteran's claim for disability benefits, including any medical records used to make the decision. All efforts to obtain these records must be documented in the claims file. 3. After the completion of #s 1 and 2 above, schedule the Veteran for a VA examination to determine whether any current testicular disorder, including epididymitis, is related to service. The entire claims file, to include his service treatment records, a copy of this Remand, and any relevant records in Virtual VA, must be made available to the examiner. The examiner should note that the claims file, to include the service and post service treatment records, was reviewed. The examiner should opine whether it is at least as likely as not (50 percent probability or more) that any current testicular disorder, including epididymitis had its onset in service, or is otherwise related to service. The examiner should provide reasons for the opinion and reconcile any differences of opinion in the record. The examiner should specifically comment on the STRs dated in November and December 1980 that included complaints of testicular pain and swelling and such diagnoses as epididymitis, orchitis, and possible gonococcal prostatitis. The examiner should consider the Veteran's reports of trauma to his testicles when he jolted his body in 1980. If the examiner cannot respond without resorting to speculation, he or she should explain why a response cannot be provided, and whether there is additional evidence that would permit the needed opinion to be provided. 4. After the completion of #s 1 and 2 above, schedule the Veteran for a VA psychiatric examination to determine whether the Veteran has a current psychiatric disorder that is related to service. The entire claims file, to include his service treatment records, a copy of this Remand, and any relevant records in Virtual VA, must be made available to the examiner. The examiner should note that the claims file, to include the service and post service treatment records, was reviewed. a) The examiner should determine whether or not the Veteran has a current diagnosis of a psychiatric disorder. b) If a psychiatric disorder is identified, the examiner should opine whether it is at least as likely as not (50 percent probability or more) that any current psychiatric disorder identified had its onset in service, or is otherwise related to service. The examiner should provide reasons for the opinion and reconcile any differences of opinion in the record. The examiner should specifically comment on any behavioral problems documented in the Veteran's service personnel records. If the examiner cannot respond without resorting to speculation, he or she should explain why a response cannot be provided, and whether there is additional evidence that would permit the needed opinion to be provided. 5. The AOJ should ensure that the examination report complies with the instructions of this remand. Thereafter, the claims for service connection should be re-adjudicated. If any benefit sought is not granted, the Veteran and his representative should be furnished a supplemental statement of the case and be afforded an opportunity to respond. Thereafter, the case should be returned to the Board for appellate review. The appellant has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This case must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ Thomas H. O'Shay Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs